What is Behavioural Intervention?

Interactions between clients and a treatment practitioner (doctor, psychiatrist, clinical psychologist, counsellor). That often take place in a medical office or hospital setting, and can happen either in groups or privately

Relapse Rates

Those who enter treatment often have a comorbid dysregulation i.e. through psychiatric illnesses, cognitive impairments, impulsivity.

Hunt (1971) - Abstinence rate tends to drop, indicative of relapse
Hughes (2004) - Similar relapse rates can be seen in self-quitters as well as those who have gone through professional treatment

Project MATCH

US$27M trial that randomly allocated alcohol patients into one of three treatment programmes.

Twelve-step facilitation (TSF)
Cognitive Behavioural Therapy (CBT)
Motivational Enhancement Therapy (MET)

Twelve-Step Facilitation (TSF)

Based on the "12-step fellowships". Willpower alone cannot achieve sustained sobriety, rather the desire for the greater good and spiritual renewal

Main goals

Acceptance for the need of abstinence
Willingness to participate

Original AA Steps

TSF Objectives

Core Topics

Elective Topics

HALT - Hungry Angry Learning Tired

Cognitive Behavioural Therapy (CBT)

Learning interpersonal and self-management skills.

Clients identify high risk situations that may increase their likelihood of renewed drinking.
They then develop skills to cope/address them

12 sessions - 8 cores, 4 electives

Urge Surfing - Figuring out new ways to approach cravings. Rather than feeling the craving, thinking of where the craving is.

Elective Topics

Motivational Enhancement Therapy (MET)

Motivational psychology designed to produce rapid, internally motivated change

4 sessions over 12 week

Stages of Change

Prochaska & DiCelemente (1986)

Results of Project MATCH

They all seem equally as (in)effective. Only ~20% of the group remained abstinent

Systems Level Analysis

Contingency Management

Dissuades addicts from use by increasing relative value of alternative activities

Herrnstein's matching law - Humans and animals will choose whichever choice of action has the greatest payoff in terms of reward relative to costs (Higgins et al 2004)

Provide addicts vouchers/money if they remain abstinent

Lussier et al 2006 - Compared difference in abstinence rates between those who received vouchers and those who received a control intervention

CM patients showed 10% in improvements

Epstein et al 2003 - Cocaine addicts were allocated to contingency management, cognitive behavioural therapy or no treatment

Abstinence rates were 10% higher in the two treatment groups at recorded points 3, 6 and 12 months.

Shows that improvements in abstinence achieved by CM are maintained for at least a year

Why should tax payers pay these people who brought it upon themselves???

3 year program where participants were only allowed to work if they were tested drug-free

Cue Extinction Therapy

Degrade the motivating effect of drug use by presenting addicts with drug cues, without the drug intoxication - such that the relationship between the stimuli (CS) and the drug effect (US) is degraded, reducing the ability of the stimulus to motivate drug use (CR)

Conklin and Tiffany 2002 - could not find any significant difference in the rates of relapse between the extinction and control group.

Memory reconsolidation processes may be important for improving the effectiveness of drug cue extinction therapy

The rats in the RET group responded less than the group that only extinction training (without the retrieval)

HOWEVER, when the treatments were reversed, there were also favourable outcomes... So maybe the order isn't important; and maybe the memory being in labile state isn't necessary.

Cue Re-training Therapy

Addictive behaviour is driven by bias.

Jones & Field 2003 - Trained heavy student drinkers on an alcohol 'stop signal' task.
Tone played after a picture was presented - do not press the button.
The alcohol restraint group learned to withhold key presses selectively in the presence of alcohol cues.

This training carried on, and the students in the alcohol restraint group consumed less beer in an unrelated taste test. However after one week, this reduction was eradicated, and students un-re-trained themselves -- short lived / easily abolished